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Negative-Pressure Wound Therapy Over Closed Incisions Decreases Wound Complications After High-Risk Total Joint Arthroplasty

February 19, 2016

Contributors: Herbert John Cooper, MD; Marcel A Bas, MD; Marcel A Bas, MD

Keywords: Complications; Infection

Introduction: Negative-pressure wound therapy (NWPT) applied over a closed incision may improve wound healing via mechanical stabilization, reduction of edema, increased vascular and lymphatic flow, and reduction of subcutaneous hematoma and seroma. The benefit of prophylactic NPWT to enhance healing of high-risk wounds after hip and knee arthroplasty has not yet been elucidated. Methods: This video reviews a retrospective case-control series of NPWT continuously used over a closed incision in high-risk patients who underwent hip and knee arthroplasty performed by a single surgeon during a 12-month period. Indications for NPWT included morbid obesity, poorly-controlled diabetes mellitus, periprosthetic joint infection, revision surgery in the early postoperative period, or multiple risk factors for poor wound healing. Wounds were assessed for breakdown, dehiscence, necrosis, suture granuloma, and superficial infection during the early postoperative period. No patients in the study group were lost to follow-up before wound healing. A matched cohort of patients from the previous 12 months who did not receive NPWT was used as a historical control group. Results: During the study period, 34 patients received NPWT, representing 21.2% of the 160 patients treated surgically during the study period. NPWT was used for a mean of 6.2 days (range, 3 to 14 days) before being discontinued. Thirty-two of the 34 wounds (94%) healed without complication, whereas two wounds (6%) required revision surgery for wound necrosis and breakdown. Nineteen of the 34 wounds (56%) in the control group healed without complication, whereas eight wounds (24%) required additional local wound care and seven wounds (21%) required revision surgery. Deep infection did not occur in any patients in the NPWT group, whereas deep infection occurred in two patients in the study group. A significantly lower wound complication rate occurred in the study group (odds ratio, 0.08; P < 0.01), and a trend toward a lower rate of revision surgery was noted (odds ratio, 0.24; P = 0.09). Conclusions: Closed-incision NPWT was associated with a considerably lower rate of wound complications in this case control series and warrants additional investigation.